Mobile health application usage and quality of care at a hypertension clinic: an observational cohort study

Abstract

Objective: The aim of this study was to test whether a physician-supervised web-based app, integrated with an electronic medical record, helps in improving blood pressure (BP) management in clinical practice. Materials and Methods: An observational study of 1633 patients seen at a hypertension clinic managed by an endocrinologist with two cohorts (726 adopted the app and 907 had not). The app allowed patients and doctors to monitor BP, blood sugar and other vital signs. Patients decided whether to opt in to using the app and how often to upload their readings. The provider could offer feedback and communicate with patients through the app. We evaluated the change in office-based BP measurement before and after app adoption (at least 12 months apart). We performed a difference-in-difference analysis along with matching based on patient-individual characteristics. Results: The difference-in-difference estimates were 6.23mmHg systolic [95% confidence interval (95% CI) 0.87–11.59] for patients with SBP 150mmHg or above, 4.01mmHg systolic (95% CI 1.11–6.91) for patients with SBP 140mmHg or above, 4.37mmHg diastolic (95% CI 1.06–7.68) for patients with DBP 90mmHg or above, 1.89mmHg systolic (95% CI 0.58–3.2) and 0.87mmHg diastolic (95% CI 0.17–1.57) overall for an average patient. Higher frequency of app usage was also associated with a greater reduction in BP. Conclusion: Use of an mHealth app in a clinical practice, was associated with a significant reduction in BP for average patients as well as high-severity patients. Physician-supervised mHealth apps in a clinical practice could be instrumental in managing patient BP.